Acquired Heard
Diseases
MSN.Khitam moh’d
Outline
1. Congestive Heart Disease 
2. Rheumatic fever 
3. Kawasaki Disease 
Congestive Heart Disease
CHF … the heart cannot pump & circulate 
enough blood to supply O2 & nutrient .
Result in decrease blood flow to the kidney
…stimulate renin angiotensin …cause fluid &Na
retention .
* Tow Type:
1. Right side HF
2. Lift side HF
ASSESSMENT
* Right side CHF :
1. Ascites
2.wt gain
3. Hepatomegaly
4. Lower extremity edema.
* Lift side CHF :
1.Dyspnea
2. Crackles 3. Tachpnea
4. Tachycardia
5. Fatigue .
In infant :
1. Rapid respiration 2. Generalized edema
feeding 3. Enlarge liver & heart
3. Poor
Nursing Diagnosis
1. Ineffective cardiac output & peripheral tissues
perfusion r/t inadequate heart function .
2. Risk for imbalance nutrient less than body
requirement
3. Fear r/t child ill appearance & outcome .
Nursing intervention
1. provide O2 as necessary
2. Provide rest periods ( semi fowler position )
3. give time for family to talk about their fear
4. Observe close for doctor visit,and medication dosage.
5. Give medication as order
* Diuretics…lasix ( B.W, UOP,ECG change ,& elec
imbalance )
* Digoxin…calculate the dosage in (ml+mg)
-HR = 100 b/min infant and 70 b/m in older child.
* Observe for digoxin (Toxicity) WHEN GIVEN AT HOME
S&S OF toxicity :
1. Anorexia 2. Dizziness
3.Nausea & Vomiting
4. Diarrhea 5. Headache & arrhythmia .
RHEUMATIC
FEVER
Occurs in group age ( 6 –15 y/d) peak 8y/d )
*Autoimmune disease occurs as a reaction to
group A-beta –hemolytic streptococcal
infection .
- major body joints
- mitral valve
- female incident more than male
attack of pharyngitis,tonsillitis & scarlet fever.
* Assessment :
1. fever
2. systolic murmur
3. Prolong PR & QT interval on ECG .
-
Nursing Care
4. Chorea ( sudden involuntary movement of
the limbs )
5. polyarthritis.
6. Erythema and arthralgia
NDX:
1. Risk for non compliance with drug therapy r/t
knowledge deficit about importance of long term
therapy .
2. Low self-esteem r/t chorea (movement secondary to
RF)
Nursing intervention
1. Prevent initial attack ( prevent
infection URTI & give Anti-B for 10
– 14 day
2. Prevent recurrent attack ( plan for
any surgical procedure )
3. Help them in feeding and DAL .
4. Low activity level sitting games
types
5. Bedside rails to prevent any
injuries
Therapeutic management
* Antibiotic for 6 – 8 week (most common
used penicillin)
* Bed rest (close bedside caring).
* V/S until return to normal value.
* Aspirin ,Ibuprofen & Corticosteriode
Kawasaki
Disease
A mucocutaneous lymph node
syndrome
Kawasaki Disease
* Cause unknown peak child boy less than 4 y of age
* Ch.ch by systemic vasculitis & may present itself as
febrile illness
**Assessment :
1. Fever lasting for more than 5 days not response to
antipyretic
2. Lethargic or irritability
3. Bilateral conjunctivitis
4. Chang of lips and oral cavity
a. Dry ,red ,fissured lips
b. Strawberry tongue
c. Diffuse erythema of mucous membranes
Chang of lips and oral cavity
a. Dry
,red ,fissured
lips
b.Strawberry tongue
c. Diffuse erythema of
mucous membranes
Criteria for diagnosis of KD
5. Changes of peripheral extremities
a. Erythema of palms and soles
b. Indurative edema of hands and feet
c. Membranous desquamation from
fingertips
6. Polymorphous rash (primarily on
trunk)
7.
Acute non purulent swelling of cervical
lymph node to more than 1.5cm in
diameter
8. Abdomen pain ,anorexia, or diarrhea
9. Swollen red joint.
10. WBC,ESR & plat elevated may led to
clotting and sudden death
Kawasaki Disease
Coronary aneurysm
Kawasaki disease
* Stage 2 of the KD…convalescent phase ( 25 –
40 days)
* Stage 3 of the KD…until ESR return to
normal
* Diagnostic Test :
1. CBC, WBC differ & ESR.
2. Echo
*Therapeutic management :
1. Aspirin ( high doses)
2. Immune globulin.
Nursing Care diagnosis and intervention
* The most common NDx:
1. Pain r/t swelling of lymph node and joint
inflammation
2.risk for ineffective peripheral tissue perfusion r/t
inflammation of blood vessels.
* Nursing Role :
1.Assess S&S of CHF ,ECG change
2.blood test for plat count
3. Anti-inflammatory & anti-pyretic
Nursing Role
4. Comfortable
measure ( position, special
games)
5. Hydration to decrease mouth tenderness.
6. Record I&O.
7. Soft food non-irritant
8. In some cases you have to prepare for
surgical treatment child with CAD.